Provider Demographics
NPI:1932802493
Name:GALE, REE ANNA (LAC)
Entity type:Individual
Prefix:
First Name:REE
Middle Name:ANNA
Last Name:GALE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-9609
Mailing Address - Country:US
Mailing Address - Phone:619-206-5104
Mailing Address - Fax:
Practice Address - Street 1:1813 JOSEPH ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-9609
Practice Address - Country:US
Practice Address - Phone:619-206-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA70006916171100000X
HIACU-1444-0171100000X
CA49739225700000X
ID8861560171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty